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Hospital Outcomes of Spontaneous Coronary Artery Dissection With Concurrent Ventricular Arrhythmias
Min Choon Tan1,2, Yong Hao Yeo3, Qi Xuan Ang4
1Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona.
Insights
Spontaneous coronary artery dissection (SCAD) with ventricular arrhythmias (VA) leads to worse hospital outcomes, including higher mortality and longer stays. Heart failure and chronic liver disease are key factors associated with VA in SCAD patients.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- Spontaneous coronary artery dissection (SCAD) is a condition where a tear occurs in the wall of a coronary artery.
- Ventricular arrhythmias (VA) can occur concurrently with SCAD, but their impact on in-hospital outcomes in the US is not well-established.
- This study investigates the outcomes of SCAD patients with and without VA in the US.
Purpose of the Study:
- To analyze in-hospital outcomes of patients with SCAD and concurrent VA.
- To determine factors associated with VA occurrence in SCAD patients.
- To provide insights into managing this high-risk population.
Main Methods:
- Utilized the Nationwide Readmissions Database (2017-2020) for patients aged 18+ with SCAD.
- Categorized patients into groups with and without VA during hospitalization.
- Performed weighted, univariable, and multivariable analyses to assess outcomes and associated factors.
Main Results:
- SCAD patients with VA (13.5%) had significantly higher rates of early mortality (10.2% vs 2.0%), prolonged hospital stay (33.1% vs 11.7%), and non-home discharge (21.2% vs 5.9%).
- VA was associated with longer hospital stays (7.39 vs 3.58 days) and higher hospitalization costs ($31,451 vs $13,802).
- Increased adverse events in SCAD patients with VA included heart failure, cardiac arrest, cardiogenic shock, and acute kidney injury. Independent factors for VA were chronic liver disease and heart failure.
Conclusions:
- Ventricular arrhythmias in SCAD patients are linked to significantly poorer in-hospital outcomes.
- Heart failure and chronic liver disease are identified as independent risk factors for VA occurrence in SCAD patients.
- These findings highlight the importance of monitoring for VA in SCAD patients, especially those with pre-existing heart failure or liver disease.
Background:
While patients with spontaneous coronary artery dissection (SCAD) occasionally present with concurrent ventricular arrhythmias (VA), the impact of VA on in-hospital outcomes in the United States (US) is not well-established. This study aims to analyze in-hospital outcomes of patients with SCAD and concurrent VA and to determine the factors associated with VA occurrence in this high-risk population in the US.
Methods:
Using the Nationwide Readmissions Database, our study included patients age 18 years or older who had SCAD between 2017 and 2020. We categorized the cohort into 2 groups depending on the presence of VA during hospitalization. In-hospital outcomes were assessed between SCAD patients with VA and those without. Weighted analysis was performed. We analyzed the independent factors associated with VA occurring among SCAD patients through univariable and multivariable analyses.
Results:
Eight hundred seventy-seven SCAD patients were included in the study: 118 (13.5%) with VA and 759 (86.6%) without. SCAD patients with concurrent VA were associated with higher rates of early mortality (10.2% vs 2.0%; P < .01), prolonged index hospital stay (≥7 days) (33.1% vs 11.7%; P < .01), and non-home discharge (21.2% vs 5.9%; P < .01). The length of hospital stay was longer in the SCAD with concurrent VA group (7.39 days vs 3.58 days; P < .01), and the median cumulative cost of hospitalization was also higher in this group ($31,451 vs $13,802; P < .01). SCAD patients with concurrent VA had increased in-hospital adverse events: acute heart failure, cardiac arrest, cardiogenic shock, cerebral infarction, pulmonary edema, and acute kidney injury. In multivariable analysis, the independent factors associated with VA occurrence among SCAD patients were chronic liver disease (aOR, 3.42; 95% CI, 1.43-8.20; P < .01) and heart failure (aOR, 5.63; 95% CI, 3.36-9.42; P < .01).
Conclusions:
Concurrence of VA among SCAD patients was associated with poorer in-hospital outcomes. Heart failure and chronic liver disease were the independent factors associated with VA occurrence in SCAD patients.
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